Individual
JON W HANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10 DNR RD, MC GRATH, AK 99627-0159
(907) 524-3299
(907) 524-3805
Mailing address
10 DNR RD, MC GRATH, AK 99627-0159
(907) 524-3299
(907) 524-3805
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2206
STATE LICENSE
OK
01
—
PHS000
IHS
OK
Enumeration date
01/03/2013
Last updated
07/11/2024
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